MENTAL STRESS, AUTONOMIC FUNCTION, AND HEART DISEASE

说明： 精神压力与心血管疾病之间的密切联系 冠状动脉疾病(CAD)患者的事件可能源于 应激诱导的心肌缺血，由于血管的夸大增加 阻力和动脉压。事实上，这可能解释了部分原因 压力感受性心脏迷走神经控制与预后的关系 冠心病患者的心血管结局。血液动力学反应的变化 心理压力通过动脉压力感受器反射来缓冲；因此， 对精神压力的夸大升压反应可能是由于精神受损 冠心病患者的压力感受性反射调节。这项建议的具体目的 1)描述血管硬度和血管硬度之间的关系 冠心病患者的压力感受性反射调节，并与健康对照组进行对照 冠心病患者的受试者；2)检查，与个人相关 对压力感受器反射功能的药理学估计的差异， 实验室心理过程中自主神经和压力反射控制的变化 冠心病患者和健康对照组的应激反应；3)测试 冠心病患者压力感受性反射调节受损的假设 血管僵硬增加和/或自主神经控制减弱 与对心理压力的血流动力学反应加剧有关。 静脉推注血管活性药物结合Finapres逐次输注 动脉血压和颈动脉B超将用于 评估压力反射敏感性和动脉僵硬。压力感受性反射 对心理压力的调整将由权力来评估 动脉压与心脏变时性之间的频谱衍生关系 在一次心算任务和一次语音任务中。在多大程度上 压力感受性反射功能指数与血流动力学反应有关 将评估冠心病患者的心理压力。没有数据 颈动脉或主动脉僵硬与心血管控制之间的关系 健康人群或冠心病人群的精神压力。因此，这项研究可能 提供对机制和心理生理相关性的独特见解 冠心病患者压力感受性反射敏感度降低。

DESCRIPTION: The strong association between mental stress and morbid cardiovascular events in coronary artery disease (CAD) patients may derive from stress-induced cardiac ischemia due to exaggerated increases in vascular resistance and arterial pressure. In fact, this may explain part of the prognostic relationship of baroreflex cardiac vagal control to cardiovascular outcome among CAD patients. The hemodynamic responses to psychological stress are buffered by the arterial baroreflex; thus, exaggerated pressor responses to mental stress may result from impaired baroreflex regulation in CAD patients. The specific aims of this proposal are: 1) to characterize relationships between vascular stiffness and baroreflex regulation among CAD patients, also contrasting healthy control subjects with CAD patients; 2) to examine, in relation to individual differences in pharmacologically derived estimates of baroreflex function, changes in autonomic and baroreflex control during laboratory psychological stress among CAD patients and among healthy control subjects; 3) to test the hypothesis that impaired baroreflex regulation in CAD patients, due to increased vascular stiffness and/or attenuated autonomic control, is associated with exacerbated hemodynamic reactions to psychological stress. Bolus vasoactive drug infusions in combination with Finapres beat-by-beat arterial pressures and carotid B-mode ultrasonography will be used to evaluate baroreflex sensitivity and arterial stiffness. Baroreflex adjustments to psychological stress will be assessed by power spectral-derived relations between arterial pressure and cardiac chronotropy during a mental arithmetic task and a speech task. The degree to which indices of baroreflex function are associated with hemodynamic responses to psychological stress among CAD patients will be assessed. There are no data which related carotid or aortic stiffness to cardiovascular control during mental stress in healthy or CAD populations. Thus, this research may provide unique insight to the mechanism and psycho-physiological correlates of reduced baroreflex sensitivity in CAD patients.